Best practice recommendations on the application of seclusion and restraint in mental health services: An evidence, human rights and consensus-based approach

Kathleen De Cuyper, Els Vanlinthout, Tim Pieter Lieven Opgenhaffen, Jasper Vanhoof, Theo Van Achterberg, Sara Nijs, Tine Peeters, Johan Put, Bea Maes, Chantal Van Audenhove

Research output: Contribution to journalArticlepeer-review


Seclusion and restraint still regularly occur within inpatient mental health services. The Council of Europe requires the development of a policy on for instance age limits, techniques and time limits. However, they only define the outer limits of such a policy by indicating when rights are violated. Within these limits, many choices remain open. Staff and service managers lack clarity on safe and humane procedures. Research literature provides limited and contradictory insights on these matters. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study resulted in 77 best practice recommendations on the practical application of restraint and seclusion as last resort intervention in inpatient youth and adult mental health services, including forensic facilities. To our knowledge, this is the first study in which the development of recommendations on this topic is not only based on scientific evidence, but also on an analysis of European human rights standards and consensus within and between expert-professionals and experts-by-experience. This approach allowed to develop for the first time recommendations on time limits, asking for second opinion, and registration of seclusion and restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The 77 recommendations encourage staff to focus on teamwork, safety measures, humane treatment, age and time limits, asking for second opinion, observation, evaluation and registration when applying seclusion and restraint as last resort intervention. The implementation of the best practice recommendations is feasible provided that they are combined with a broad preventive approach and with collaboration between service managers, staff (educators) and experts-by-experience. Under these conditions, the recommendations will improve safety and humane treatment, and reduce harm to both service users and staff.
Original languageEnglish
Pages (from-to)580-593
Number of pages14
JournalJournal of Psychiatric and Mental Health Nursing
Issue number3
Early online date24 Dec 2022
Publication statusPublished - 1 Jun 2023

Bibliographical note

Funding Information:
This work was supported by the Flemish Government within the framework of the Policy Research Centre Well‐Being, Public Health and Family, with ref. nr. 3 M180198.

Publisher Copyright:
© 2022 John Wiley & Sons Ltd.

Copyright 2023 Elsevier B.V., All rights reserved.


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